Performance of a simplified termination of resuscitation rule for adult traumatic cardiopulmonary arrest in the prehospital setting

Chiang, Wen-Chu; Huang, Yu; Hsu, Shu Hsien; Chang, Anna Marie; Ko, Patrick Chow In; Wang, Hui-Chih; Yang, Chih‐Wei; Hsieh, Ming‐Ju; Huang, Edward Pei-Chuan; Chong, Kah Meng; Sun, Jen Tang; Chen, Shey-Ying; Ming, Matthew Huei

doi:10.1136/emermed-2014-204493

Cited by 10 publications

(8 citation statements)

References 19 publications

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“…Most included studies ( n = 21) were published between 2016 and 2019 [ 27 – 47 ], and most of the 36 primary studies were carried out in either Europe ( n = 14) [ 2 , 3 , 6 , 19 – 21 , 28 , 32 , 33 , 35 , 36 , 40 , 44 , 46 ] or Asia ( n = 13) [ 22 , 25 , 26 , 30 , 31 , 34 , 37 – 39 , 41 , 43 , 45 , 47 ]. Almost all included studies were retrospective cohort studies ( n = 32) [ 1 – 3 , 16 – 18 , 20 – 38 , 40 – 44 , 46 , 47 ] and included both penetrating and blunt trauma cases ( n = 30) [ 1 – 3 , 16 , 17 , 19 – 21 , 23 – 25 , 27 , 28 , 30 – 36 , 40 – 47 ].…”

Section: Resultsmentioning

confidence: 99%

“…2 ). Within the 36 included studies, 13 studies reported neurological outcome as defined in the methods section [ 1 , 2 , 19 – 22 , 25 , 26 , 30 , 31 , 33 , 37 , 43 ]. Of all TCA survivors, a (pooled) favorable neurological outcome was observed in 43.5% of the TCA survival patients (95% CI 32.3–55.0).…”

Section: Resultsmentioning

confidence: 99%

“…Likewise, neurological outcome was investigated for different database types by calculating the pooled proportion of surviving patients with a favorable neurological outcome for nine studies [ 21 , 22 , 25 , 26 , 29 – 31 , 37 , 43 ] including and for four studies excluding prehospital deaths separately (Fig. 4 ) [ 2 , 19 , 20 , 33 ].…”

Section: Resultsmentioning

confidence: 99%

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Prehospital traumatic cardiac arrest: a systematic review and meta-analysis

Vianen

Lieshout

Maissan

et al. 2022

Eur J Trauma Emerg Surg

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Background Circulatory arrest after trauma is a life-threatening situation that mandates urgent action. The aims of this systematic review and meta-analysis on prehospital traumatic cardiac arrest (TCA) were to provide an updated pooled mortality rate for prehospital TCA, to investigate the impact of the time of patient inclusion and the type of prehospital trauma system on TCA mortality rates and neurological outcome, and to investigate which pre- and intra-arrest factors are prognostic for prehospital TCA mortality. Methods This review was conducted in accordance with the PRISMA and CHARMS guidelines. Databases were searched for primary studies published about prehospital TCA patients (1995–2020). Studies were divided into various EMS-system categories. Data were analyzed using MedCalc, Review Manager, Microsoft Excel, and Shinyapps Meta Power Calculator software. Results Thirty-six studies involving 51.722 patients were included. Overall mortality for TCA was 96.2% and a favorable neurological outcome was seen in 43.5% of the survivors. Mortality rates were 97.2% in studies including prehospital deaths and 92.3% in studies excluding prehospital deaths. Favorable neurological outcome rates were 35.8% in studies including prehospital deaths and 49.5% in studies excluding prehospital deaths. Mortality rates were 97.6% if no physician was available at the prehospital scene and 93.9% if a physician was available. Favorable neurological outcome rates were 57.0% if no physician was available at the prehospital scene and 38.0% if a physician was available. Only non-shockable rhythm was associated with a higher mortality (RR 1.12, p = 0.06). Conclusion Approximately 1 in 20 patients with prehospital TCA will survive; about 40% of survivors have favorable neurological outcome.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Prehospital traumatic cardiac arrest: a systematic review and meta-analysis

Vianen

Lieshout

Maissan

et al. 2022

Eur J Trauma Emerg Surg

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“…We identified very-low-certainty evidence (downgraded for risk of bias, inconsistency, indirectness, and imprecision) from 12 nonrandomized studies. 48,51,56,57,65,66,75,76,79 , Between them these studies derived and internally validated 15 distinct TOR rules to predict death after arrival at hospital. Studies by Lee et al {Lee 2019 e134} and Yoon et al { Yoon 2019, 73} derived multiple TOR rules.…”

Section: Death In Hospitalmentioning

confidence: 99%

Education, Implementation, and Teams: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations

Greif¹,

Bhanji²,

Bigham³

et al. 2020

Circulation

Self Cite

152

133

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For this 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations , the Education, Implementation, and Teams Task Force applied the population, intervention, comparator, outcome, study design, time frame format and performed 15 systematic reviews, applying the Grading of Recommendations, Assessment, Development, and Evaluation guidance. Furthermore, 4 scoping reviews and 7 evidence updates assessed any new evidence to determine if a change in any existing treatment recommendation was required. The topics covered included training for the treatment of opioid overdose; basic life support, including automated external defibrillator training; measuring implementation and performance in communities, and cardiac arrest centers; advanced life support training, including team and leadership training and rapid response teams; measuring cardiopulmonary resuscitation performance, feedback devices, and debriefing; and the use of social media to improve cardiopulmonary resuscitation application.

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“… For this category 25 of the 29 articles could be retrieved and analyzed. Of the nine articles in the Clinical Protocol theme, there were two articles on non-invasive near-infrared spectroscopy (NIRS) [ 65 , 66 ], two on therapeutic hypothermia [ 67 , 68 ], and two on termination of resuscitation [ 69 , 70 ]. There was one article respectively on double sequential external defibrillation [ 71 ], extracorporeal CPR [ 72 ], and CPR induced consciousness [ 73 ].…”

Section: Resultsmentioning

confidence: 99%

Looking back to inform the future: a review of published paramedicine research

Cavanagh

Blanchard

Weiss

et al. 2023

BMC Health Serv Res

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Objective Paramedicine has evolved in ways that may outpace the science informing these changes. Examining the scholarly pursuits of paramedicine may provide insights into the historical academic focus, which may inform future endeavors and evolution of paramedicine. The objective of this study was to explore the existing discourse in paramedicine research to reflect on the academic pursuits of this community. Methods We searched Medline, Embase, CINAHL, Google Scholar and Web of Science from January, 2006 to April, 2019. We further refined the yield using a ranking formula that prioritized journals most relevant to paramedicine, then sampled randomly in two-year clusters for full text review. We extracted literature type, study topic and context, then used elements of qualitative content, thematic, and discourse analysis to further describe the sample. Results The initial search yielded 99,124 citations, leaving 54,638 after removing duplicates and 7084 relevant articles from nine journals after ranking. Subsequently, 2058 articles were included for topic categorization, and 241 papers were included for full text analysis after random sampling. Overall, this literature reveals: 1) a relatively narrow topic focus, given the majority of research has concentrated on general operational activities and specific clinical conditions and interventions (e.g., resuscitation, airway management, etc.); 2) a limited methodological (and possibly philosophical) focus, given that most were observational studies (e.g., cohort, case control, and case series) or editorial/commentary; 3) a variety of observed trajectories of academic attention, indicating where the evolution of paramedicine is evident, areas where scope of practice is uncertain, and areas that aim to improve skills historically considered core to paramedic clinical practice. Conclusions Included articles suggest a relatively narrow topic focus, a limited methodological focus, and observed trajectories of academic attention indicating where research pursuits and priorities are shifting. We have highlighted that the academic focus may require an alignment with aspirational and direction setting documents aimed at developing paramedicine. This review may be a snapshot of scholarly activity that reflects a young medically directed profession and systems focusing on a few high acuity conditions, with aspirations of professional autonomy contributing to the health and social well-being of communities.

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Performance of a simplified termination of resuscitation rule for adult traumatic cardiopulmonary arrest in the prehospital setting

Abstract: The simplified TOR rule appears to accurately predict non-survivors in adults with TCPA in the prehospital setting.

Cited by 10 publications

References 19 publications

Prehospital traumatic cardiac arrest: a systematic review and meta-analysis

Prehospital traumatic cardiac arrest: a systematic review and meta-analysis

Education, Implementation, and Teams: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations

Looking back to inform the future: a review of published paramedicine research

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